SECC Club Ministries

Registration and insurance form

What this is. This is the Southeastern California Conference’s own registration and insurance form for the Adventurer Club, ages 3 to 10 — the same one the club hands out on paper. Fill it in here and sign at the bottom, and a completed PDF goes to the church office, to the club directors, and to you. Registering more than one child? Add them all below — you only type your own details once. Keep your copy; the conference asks that you hold one.

Your details

Filled in once, however many children you are registering.

Church the club belongs to

Phone

Address

City

ZIP code

We email a link here first; press it and your signed copy follows.

Name of the club you are joining

Who are you registering?

One block per child. The conference registers each child separately, so each one gets their own signed form — but you only type your own details once, above. Registering one child? Fill in the one block and ignore the rest — use the button underneath to add a second only if you need it. A blank block is skipped.

Child 1

Full name

Age

Birth date

Grade in school

School you attend

Church you attend

Applicant’s signature — type their full name

Typing the name is binding, exactly as the conference’s paper form says. For a young child, a parent types it for them.

Child 2

Full name

Age

Birth date

Grade in school

School you attend

Church you attend

Applicant’s signature — type their full name

Typing the name is binding, exactly as the conference’s paper form says. For a young child, a parent types it for them.

Each applicant’s agreement

I will plan to attend club meetings, outings, and activities. I will proudly wear my Adventurer uniform. I will obey club rules and understand that they have been made for my safety and that of my peers. I will be cheerful, helpful, honest, kind and courteous.

Each child above agrees to this by having their name typed into their block.

Approval and consent of parent or guardian

As parent(s)/guardian(s), I/we understand that the Adventurer program is an active one, which includes many opportunities for service, adventure, fun and learning. I/we will support the program by:

Encouraging my Adventurer to take an active part in all club meetings and functions
Attending club activities and outings
Assisting club leaders by serving as a helper when needed
Not holding any individual club staff member liable in the event of injury
Giving my permission for the above named Adventurer to attend all Adventurer activities
Paying Southeastern CA Conference registration/insurance fees in the amount of $10
Paying local club fees in the amount of $65

About the fees. $75 per child, per year — $65 for the club and $10 for the conference’s registration and insurance. Nothing is charged on this page and no card details are asked for anywhere on this site. Pay the full $75 per child to the church on Venmo: @redlandschurch, or by cash or check to a director — the church passes the conference’s $10 on, so there is nothing to send them separately. Sending this form and paying are separate — do them in whichever order suits you.

I/we have read and understand the foregoing.

Please confirm the participation of the children named above I give permission for them to participate in Adventurer Club with the sponsoring organization.

Parent or guardian’s signature — type the full name

Completing this form and typing in your name is considered binding. A copy of each completed document is emailed to you once you confirm your email address.